People using a wheelchair are affected by many conditions including cerebral palsy, quadriplegia, paraplegia, stroke, kyphosis, scoliosis, old age, multiple sclerosis and head injuries, among other debilitating physical conditions. These individuals often suffer from edema (pooling of fluid in areas of poor vascular flow), loss of memory, subluxation of the shoulder, trunk control, limited range of motion, and many safety concerns.
One of the most common complaints of wheelchair occupants is that of pain that is directly related to their use of a wheelchair. Unfortunately, at least some of the problems faced by wheelchair users are further exacerbated by the failure of current designs of wheelchair armrest pads and armrest pad systems to properly position a wheelchair occupant. An armrest pad that can be adjusted to meet the individual needs of people that have a variety of disabilities is needed.
For example, some stroke patients need to have an armrest pad adjusted to maintain the correct pressure on the shoulder joint to prevent subluxation of the humeral head, which can lead to irreversible damage and shoulder pain. Stroke patients may need their arm to be in their field of view as a cognitive reminder of its existence, which can help prevent them from hitting their arm on door frames or from falling into the wheels of a wheelchair. Depending on the user's post-stroke stage, whether flaccid or spastic, a properly adjusted armrest will help maintain shoulder integrity and prevent the spine from flexing laterally by compensating for loss of righting muscles.
Proper arm support also improves shoulder girdle stability. Stability of the shoulder girdle allows for an upright trunk which facilitates an upright and vertical head position. Armrests can help many cerebral palsy patients and others without trunk and head control perform activities of daily living. For example, it is very difficult to maintain one's head in the correct position, as it is a large mass connected with a series of intricate structural and muscular systems. When a person has any type of structural, muscular or nervous system disability, frequently, proper head position is difficult to maintain, which can cause further health problems. Maintaining proper shoulder girdle alignment is the first step to maintaining proper head alignment.
Proper positioning of an armrest can also help maintain upper extremity range of motion and prevent contracture. Many quadriplegic, paraplegic, and other disabled patients may have limited or no use of their arms and shoulders. An armrest can help prevent contracture, that is, prevent the muscles in the arm and hand from contracting. It is imperative to treat patients at risk of contracture early and to maintain a regimented schedule of therapy. Once the arm is in contracture, it is difficult to restore the arm to a “normal” position.
An additional problem exists relative to hand position. An open hand position is important for two reasons: hygiene and protection of the hand muscle and tissue. If the hand is permitted to close, it will often overheat and cause other hygiene issues. Additionally, it is difficult for care givers to open and clean a hand in contracture. Further, when the hand is closed tightly, finger nails will often dig into the palm thereby damaging or degrading the muscle and or tissue in the palm. Contracture and an open hand position can be controlled when the arm is properly positioned with an armrest.
Yet another problem is edema, which is pooling of the fluid in the body, often as a result of surgery or trauma. Elevating the hand above the elbow can help prevent fluid build up. However, effective edema prevention requires elevation of the entire extremity above the heart. Simply elevating the hand provides only temporary protection. In such cases, the fluid will most likely remain in the arm, not the hand, where circulation is typically better.
An additional problem users face is that of safety. Door frames and other obstacles can pose significant hazards to wheelchair users who are unable to move their arms out of harm's way during wheelchair movement.
A further problem with current wheelchair armrest systems is the variability between commercially available wheelchairs. In particular, the armrest tubes of the wheelchair, often differ in configuration between wheelchairs. Specifically, in the inventor's experience, the diameter of the wheelchair armrest tubes may vary from between ⅝″ to 1.0″.
Problems with existing armrests also include excessive stack height between the wheelchair armrest tube and the armrest pad. As the armrest tube height is a fixed distance, increasing that height of the armrest tube by adding a bulky mechanism increases the stack height, which, for smaller users, can raise the armrest beyond a useable range. Additionally, if the armrest hardware elevates the pad, it may push the shoulder girdle out of alignment causing structural asymmetries and potential loss of head and trunk control.
Another problem with existing armrests is the location of the axis of rotation. The axis of rotation for the elevating and articulating functions should be anatomically correct, that is, variable to accommodate the various users of wheelchairs to prevent unwanted side effects during the treatment process.
Accordingly, what is required is an arm pad and mounting apparatus that can elevate the hand about the elbow axis, articulate about the humerus axis, slide forward to accommodate varying chest trunk thicknesses, and adjust to accommodate varying chest trunk widths. The arm pad and mounting apparatus should be adjustable while the user is seated and from the outside of the wheelchair, thereby helping to protect the patient by reducing transfers into and out of the wheelchair. Providing for adjustability while the user is seated also expedites the fitting process and allows the therapist to spend more time fine tuning the fit.
Further requirements include a wheelchair armrest and mounting apparatus that is adaptable to wheelchairs having an armrest tube, having a wide variety of different diameters configurations. There is also a need to provide a wheelchair arm mounting apparatus and system that provides a wide variety of adjustability so that it can fit all shapes and sizes of people. Lastly, such an armrest mounting apparatus must help accommodate patients with a wide variety of disabilities.